Salvage Dual LDLT for HCC after Major Hepatectomy

Abstract

Recurrence is the most frequent cause of treatment failure after hepatocellular carcinoma (HCC) resection. Salvage liver transplantation is a rescue treatment for recurrent HCC. However, salvage LT is considered about the technical feasibility in patients who have undergone prior liver surgery. Especially prior performance of a major liver resection, such as right lobectomy, makes subsequent recipient hepatectomy technically difficult. We report a successful case about salvage dual living donor liver transplantation(LDLT) after major hepatectomy. A 48-year-old male was transferred to our hospital because of gastrointestinal bleeding. He underwent the right hepatectomy due to hepatocelluar carcinoma four years ago. The gastroduodenoscopy and computed tomography demonstrated variceal beeding at duodenal 3rd portion. We performed transjugular intrahepatic portosystemic shunt(TIPS) and the coil embolization of collaterals. We recommended LDLT and because the right lobe volume of one donor, his wife was was not sufficient for the recipient and right to left lobe proportion of the other donor, his young sister is smaller than 30%, we performed dual LDLT from two donors who were his wife and young sister. At the operation, portal vein anastomosis of the right lobe graft was done using an interposing cadaveric iliac vein graft and the right gastroepiploic artery was anastomosed to the hepatic artery of the left lobe graft. Adequate portal venous and hepatic artery blood flow was demonstrated by intraoperative and postoperative Doppler ultrasound studies. Salvage dual LDLT could be undertaken successfully in adult patients with prior major hepatectomy under the accurate preoperative planning and proper surgical techniques.